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General NPI Number Information
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NPI Number | 1497181358
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Entity Type | Individual
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Provider Name | JENNIFER ANN BLACKWOOD PT
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Gender | Female
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Dates
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Enumeration Date | 09/23/2013
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 16151 MEREDITH CT
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City | LINDEN
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State | MI
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Zip | 48451-9095
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Country | US
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Telephone | 810-354-5915
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Fax |
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Provider Business Mailing Address
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Address Line | 16151 MEREDITH CT
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City | LINDEN
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State | MI
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Zip | 48451-9095
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Country | US
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Telephone | 810-354-5915
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | 5501011124
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | 009534
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License Number State | OH
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